Identification of core symptoms and symptom clusters in primary hepatocellular carcinoma during the intermittent period between transcatheter arterial chemoembolization treatments

Introduction: Patients with liver cancer frequently receive multiple transcatheter arterial chemoembolization (TACE) treatments. While some studies have investigated the symptoms and symptom clusters that occur following TACE, there is limited understanding of the core symptoms and symptom clusters experienced during the intervals between TACE treatments. Objective: This study aims to identify core symptoms and symptom clusters in patients with primary hepatocellular carcinoma (HCC) during the intermittent period of TACE, providing a reference for precise symptom management. Methods: A convenience sample of 344 patients undergoing intermittent TACE was recruited. Symptom prevalence and severity were evaluated using the Chinese version of the MD Anderson symptom inventory and the HCC-specific symptom module. Principal component analysis was used to extract symptom clusters. A symptom network was constructed to illustrate inter-symptom relationships and to calculate centrality indices. Results: Four symptom clusters were identified: upper gastrointestinal, feeling of illness, emotional-psychological, and liver function impairment. Lack of appetite demonstrated the highest strength (rs = 1.10) and closeness (rc = 0.0076) centrality in the symptom network. The strongest marginal association was found between distress and sadness (r = 0.545). Conclusion: Lack of appetite emerged as the core symptom, while the emotional–psychological cluster was the core symptom cluster. Nursing interventions should prioritize addressing appetite loss and managing emotional symptoms such as distress and sadness to enhance the effectiveness of symptom management during the intermittent period of TACE in patients with primary HCC.